Breast cancer: MONALEESA-3 trial

Abbreviations

No EU-CTR

  • MONALEESA-3 references
    2020-02-06
    Dennis J. Slamon
    Overall Survival with Ribociclib plus Fulvestrant in Advanced Breast Cancer
    2018-08-20
    Dennis J. Slamon

    JCO

    Phase III Randomized Study of Ribociclib and Fulvestrant in Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Advanced Breast Cancer
Investigated (inv)
Comparator (comp)

RIBO+fulv

PLB+fulv

484

242

Phase:

3

Randomisation:

Double blind

Primary tumour:

Breast

Subtype (biomarker):

HER2 neg., HR poz.

Stage:

meta

Line of therapy:

L1

Primary
RIBO+fulv
PLB+fulv
HR
p
PFS
20.5 mo
12.8 mo
0.59 (0.48-0.73)
<0.001
OS @42mo
57.8%
45.9%
0.72 (0.57-0.92)
0.00455
Secondaries
RIBO+fulv
PLB+fulv
HR
p
PFS in L1
33.6 mo
19.2 mo
0.55 (0.42-0.72)
-
ORR
32.4%
21.5%
-
<0.001
ORR pts. with measurable disease
40.9%
28.7%
-
0.003
PFS in L2
14.6 mo
9.1 mo
0.57 (0.44-0.74)
na
(all grades, %)
RIBO+fulv
PLB+fulv
p
Neutropenia
71.6%
2.9%
NA
Leukopenia
30.6%
1.7%
NA
Anemia
19.0%
7.1%
NA
Thrombocytopenia
8.9%
2.1%
NA
Infections
57.8%
44.4%
NA
Pulmonary disorders
37.3%
31.5%
NA
Hepatobiliary toxicity
23.6%
17.4%
NA
Renal toxicity
12.6%
5.0%
NA
QT interval prolongation
8.3%
2.1%
NA
Pulmonary embolism
4.8%
0.8%
NA
Interstitial lung disease
1.2%
0.8%
NA
Reproductive toxicity
0.4%
0.4%
NA
  • Inclusion
  • Exclusion

• Patient is an adult male/female ≥ 18 years old at the time of informed consent and has signed informed consent before any trial related activities and according to local guidelines. Female patients must be postmenopausal. • Patient has a histologically and/or cytologically confirmed diagnosis of estrogen-receptor positive and/or progesterone receptor positive breast cancer by local laboratory and has HER2-negative breast cancer. • Patient must have either measurable disease by RECIST 1.1 or at least one predominantly lytic bone lesion. • Patient has advanced (loco regionally recurrent not amenable to curative therapy, e.g. surgery and/or radiotherapy, or metastatic) breast cancer. Patients may be: - newly diagnosed advanced/metastatic breast cancer, treatment naïve - relapsed with documented evidence of relapse more than 12 months from completion of (neo)adjuvant endocrine therapy with no treatment for advanced/metastatic disease - relapsed with documented evidence of relapse on or within 12 months from completion of (neo)adjuvant endocrine therapy with no treatment for advanced/metastatic disease - relapsed with documented evidence of relapse more than 12 months from completion of adjuvant endocrine therapy and then subsequently progressed with documented evidence of progression after one line of endocrine therapy (with either an antiestrogen or an aromatase inhibitor) for advanced/metastatic disease - newly diagnosed advanced/metastatic breast cancer at diagnosis that progressed with documented evidence of progression after one line of endocrine therapy (with either an antiestrogen or an aromatase inhibitor) • Patient has an Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1 • Patient has adequate bone marrow and organ function Other Protocol-defined Inclusion/Exclusion may apply.

• Patient with symptomatic visceral disease or any disease burden that makes the patient ineligible for endocrine therapy per the investigator's best judgment. • Patient has received prior treatment with chemotherapy (except for neoadjuvant/ adjuvant chemotherapy), fulvestrant or any CDK4/6 inhibitor. • Patient with inflammatory breast cancer at screening . • Patient with CNS involvement unless they are at least 4 weeks from prior therapy completion to starting the study treatment and have stable CNS tumor at the time of screening and not receiving steroids and/or enzyme inducing anti-epileptic medications for brain metastases • Clinically significant, uncontrolled heart disease and/or cardiac repolarization abnormality • Patient is currently receiving any of the following substances and cannot be discontinued 7 days prior to start the treatment: - Known strong inducers or inhibitors of CYP3A4/5, - That have a known risk to prolong the QT interval or induce Torsades de Pointes. - Those have a narrow therapeutic window and are predominantly metabolized through CYP3A4/5. - Herbal preparations/medications, dietary supplements. Other Protocol-defined Inclusion/Exclusion may apply.

Characteristics
RIBO+fulv
PLB+fulv
Agedc-comma sex
Median age (range) yr
63 (31-89)
63 (34–86)
Female - no.(%)
484 (100)
242 (100)
Race - no.(%)
White
406 (83.9)
213 (88.0)
Asian
45 (9.3)
18 (7.4)
Native American
5 (1.0)
1 (0.4)
Black
3 (0.6)
2 (0.8)
ECOG PS - no.(%)
0
310 (64.0)
158 (65.3)
1
173 (35.7)
83 (34.3)
Missing
1 (0.2)
1 (0.4)
Disease stage at study entry - no.(%)
II
2 (0.4)
o
III
4 (0.8)
2 (0.8)
IV
478 (98.8)
239 (98.8)
Missing
0
1 (0.4)
Hormone receptor status - no.(%)
ER positive
481 (99.4)
241 (99.6)
PgR positive
353 (72.9)
167 (69.0)
Disease-free intervaldc-comma mo - no.(%)
De novo
97 (20.0)
42 (17.4)
Non-de novo
387 (80.0)
199 (82.2)
≤12 mo
22 (4.5)
9 (3.7)
>12 mo
365 (75.4)
190 (78.5)
Prior endocrine therapy status - no.(%)
Treatment naive
238 (49.2)
129 (53.3)
≤1 line of endocrine therapy
236 (48.8)
109 (45.0)
Prior endocrine therapy setting - no.(%)
(Neo)adjuvant
289 (59.7)
142 (58.7)
Advanced
110 (22.7)
40 (16.5)
Prior chemotherapy - no.(%)
Adjuvant
209 (43.2)
101 (41.7)
Neoadjuvant
65 (13.4)
30 (12.4)
Metastatic sites - no.(%)
0
2 (0.4)
0
1
151 (31.2)
73 (30.2)
2
156 (32.2)
76 (31.4)
3
114 (23.6)
48 (19.8)
Metastatic sites - no.(%)
4
38 (7.9)
34 (14.0)
≥5
23 (4.8)
10 (4.1)
Missing
0
1 (0.4)
-
-
-
Sites of metastases - no.(%)
Bone
367 (75.8)
180 (74.4)
Bone only
103 (21.3)
51 (21.1)
Visceral
293 (60.5)
146 (60.3)
Lung
146 (30.2)
72 (29.8)
Sites of metastases - no.(%)
Liver
134 (27.7)
63 (26.0)
Lung or liver
242 (50.0)
121 (50.0)
Central nervous system
6 (1.2)
2 (0.8)
Other visceral sites
102 (21.1)
51 (21.1)
Sites of metastases - no.(%)
Lymph nodes
199 (41.1)
115 (47.5)
Soft tissue
23 (4.8)
14 (5.8)
Skin
20 (4.1)
8 (3.3)
Breast
4 (0.8)
1 (0.4)
Ad-hoc:
no.pts inv.
no.pts comp.
RIBO+fulv
PLB+fulv
HR
p
  • PFS
  • OS @42mo
analisys of PFS
RIBO+fulv
PLB+fulv
HR (95% CI)
Age
65 yr
0.61 (0.45-0.81)
≥65 yr
0.60 (0.44-0.82)
Race
White
0.56 (0.45-0.70)
Asian
1.35 (0.57-3.19)
ECOG PS
0
0.56 (0.43-0.73)
1
0.63 (0.45-0.89)
Prior endocrine therapy
Treatment naïve
0.58 (0.41-0.80)
≤1 line
0.57 (0.43-0.74)
Liver or lung involvement
Yes
0.65 (0.48-0.86)
No
0.56 (0.41-0.76)
Bone lesion only
Yes
0.38 (0.23-0.61)
No
0.66 (0.52-0.83)
No. of metastatic sites
<3
0.59 (0.45-0.77)
≥3
0.62 (0.44-0.87)
Prior tamoxifen
Yes
0.62 (0.44-0.87)
No
0.56 (0.43-0.74)
Prior AI
Yes
0.67 (0.51-0.89)
No
0.48 (0.35-0.67)
analisys of OS @42mo
RIBO+fulv
PLB+fulv
HR (95% CI)
Age
<65 yr
0.76 (0.54–1.07)
≥65 yr
0.70 (0.49–1.00)
Race
White
-
-
0.68 (0.52–0.88)
Asian
1.42 (0.46–4.33)
ECOG PS
0
-
-
0.67 (0.48–0.92)
1
-
-
0.81 (0.56–1.19)
Treatment line of endocrine-based therapy for advanced disease
First line
0.70 (0.48–1.02)
Early relapse or second line
0.73 (0.53–1.00)
Liver or lung involvement
Yes
0.81 (0.58–1.12)
No
0.65 (0.45–0.93)
Bone lesion only
Yes
0.60 (0.33–1.07)
No
0.76 (0.58–1.00)
No. of sites of metastasis
<3
0.75 (0.54–1.04)
≥3
0.73 (0.50–1.05)
Most recent therapy
Adjuvant or neoadjuvant therapy
0.77 (0.57–1.04)
Therapy for metastatic disease
0.69 (0.40–1.20)
PgR status
Positive
-
-
0.74 (0.55–1.00)
Negative
-
-
0.72 (0.45–1.15)
Hormone-receptor status
ER-positive and PgR-positive
0.73 (0.54–0.98)
Other
0.74 (0.48–1.13)